Tuberculosis is now the single biggest infectious killer of women in the world, according to an international research meeting on TB and gender held in Sweden.  Data presented by the World Health Organisation (WHO) at the meeting showed unprecedented levels of infection and deaths among women and girls: over 900 million are infected with TB world-wide, one million will die and 2.5 million will become sick this year from the disease - mainly between the ages of 15 and 44.  This makes TB the single leading cause of deaths among women of reproductive age. 

''Wives, mothers and wage earners are being cut down in their prime and the world isn't noticing,'' said Dr Paul Dolin of WHO's Global Tuberculosis Programme.  "Yet the ripple effect on families, communities and economies will be felt long after a woman has died.''  No other infectious illness creates so many orphans. 

This counters perceptions in wealthy countries where the disease is most commonly found in elderly men.  In industrialised countries, one quarter of all TB cases occur in the over-65s, compared with only ten percent in developing countries or Africa, Asia and Latin America.  In the developing world, TB is predominantly a disease of young adults: 60 per cent of all cases are young men and women of reproductive age. 

TB accounts for 9 per cent of deaths world-wide among women aged between 15 and 44, compared with war which accounts for 4 per cent, HIV 3 per cent and heart disease 3 percent.  Women of reproductive age are more susceptible to fall sick once infected with TB than men of the same age.  Women in this age group are also at greater risk from HIV infection.  As a result, in parts of Africa, young women with TB outnumber young men with TB. 

''Among leading threats to women's health, TB may be the most affordably controlled, said Professor Vinod Diwan of the Nordic School of Public Health, where the meeting was held.  ''Enormous losses to this disease have prompted a search of factors such as gender that may help us to better understand and better control the epidemic.'' 

The first major international meeting to be held on TB and gender was held on (24 - 26 May 1998) was organised by the Nordic School of Public Health Umea University and Karolinska Institute in Sweden, and co-sponsored by the Swedish International Development Co-operation Agency (SIDA) and WHO.  SIDA's Department for Research Co-operation (SAREC) supports TB and gender research.   

TB and gender experts met to draw up an agenda for research into biological epidemiological, social and cultural differences in the occurrence of TB in men and women, and their access to the TB treatment strategy DOTS, recommended by WHO.  Specific areas of research will be TB in women, adherence to treatment, and patient education. 

''Improved access to DOTS could prevent many needless deaths among and children and improve our control of this infectious killer,'' said Dr Dolin of WHO.  ''Outreach services, flexible opening hours for clinics, and health workers trained to respond to women's needs could make DOTS more user-friendly for this risk group.'' 

''We need to ensure that our health systems are delivering DOTS in ways that remove rather than reinforce inequities,'' added Professor Diwan of the Nordic School of Public Health.  ''Our interventions must protect this already vulnerable group.'' 

Directly Observed Therapy, DOTS, combines five elements: political commitment, case detection through sputum smear microscopy, directly observed short-course treatment, regular drug supplies and monitoring systems with evaluation of treatment outcome for each and every patient.  Once infectious cases have been detected using microscopy services, health and community workers and trained volunteers observe and record patients swallowing the correct dosage of anti-TB medicines, and documents that the patient has been cured. 

A1996 study by the World Bank, WHO and Harvard University shows TB as a leading cause of 'healthy years lost' among women of reproductive age.  8.7 million 'disability adjusted life years' (DALYs) were lost as a result of TB compared with 8.5 million due to sexually transmitted diseases and 2 million due to malaria. 



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Press Release WHO/40